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About the role
(25%) Analyze provider data and claims-related processes to identify gaps, risks, trends, and improvement opportunities. (20%) Support daily claim deferral, workflow management, and operational issue resolution tied to provider data dependencies.
What they're looking for
- 5 or more years of experience in claims operations, provider data, process improvement, or healthcare operations
- Experience developing metrics, reporting, and performance analysis to support operational improvement
- Experience analyzing business processes, identifying root causes, and recommending or implementing process improvements
- Must be self-motivated, detail oriented and able to prioritize workload
- Strong written and verbal communication skills, including the ability to present findings and recommendations to business partners and leadership
- Strong organizational skills with the ability to manage multiple priorities, meet deadlines, and work independently
More about this role
The Senior Process Improvement Professional supports the analysis, design, and implementation of business process needs and improvements focused on provider data quality, claims resolution, and operational efficiency. This position evaluates process performance, identifies root causes and trends, develops metrics and reporting, and recommends solutions that improve quality, reduce risk, and support timely claim processing.
The Senior Process Improvement Professional works cross-functionally with operations, business, and technology partners to support issue resolution, process modernization, testing, and continuous improvement initiatives in alignment with TRICARE and government business requirements .
(25%) Analyze provider data and claims-related processes to identify gaps, risks, trends, and improvement opportunities.
(20%) Support daily claim deferral, workflow management, and operational issue resolution tied to provider data dependencies.
(20%) Recommend and help implement process improvements that increase efficiency, accuracy, quality, and consistency.
(15%) Develop metrics, reporting, and root cause analyses to measure performance and guide improvement efforts.
(10%)...
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